Peering Through the Haze

They sure know how to bury the lead at the Centers for Disease Control and Prevention.

On Thursday, the C.D.C. issued its annual National Youth Tobacco Survey; the headline in the accompanying news release read: “E-cigarette use triples among middle and high school students in just one year.”

This was, indeed, true. In 2014, according to the survey results, 13.4 percent of high school students had used an electronic cigarette at least once during the month the survey was taken. That was up from 4.5 percent in 2013.

In a conference call with reporters, Tom Frieden, the director of the C.D.C., couldn’t stop talking about how awful this was. “It’s important that everyone, parents and kids, understand that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette or a cigar,” he said. In addition to being addictive, nicotine was thought to affect the still-maturing adolescent brain — although Frieden also acknowledged that this had mainly been shown in animal studies, rather than studies of adolescents.

What’s more, he feared that there was a “significant likelihood that a proportion of those who are using e-cigarettes will go on to use combustible cigarettes.”

“That this is happening,” Frieden added, “is alarming.”

And yet buried in the news release — and played down by Frieden and others at the C.D.C. — was an astonishing fact. Actual cigarette smoking — the kind that requires inhaling carcinogens, that kills one out of every two long-term smokers and that public health officials have been trying to eradicate for decades — that kind of smoking has dropped to a mere 9.2 percent among teens.

That is a 25 percent drop in a year, a nearly 42 percent drop since 2011—and the first time that teen smoking in America has ever hit single digits. That sure sounds like big news to me.

In fact, to take it a step further, it seems pretty obvious that the decline in cigarette smoking has largely been caused by the rising popularity of e-cigarettes. This, too, was denied by Frieden. But as David Sweanor, a tobacco policy expert at the University of Ottawa, put it to me: “What other huge interventions have there been? It’s not like there has been a big new cigarette tax, or tough new package warnings. The only thing that is new is the introduction of e-cigarettes.”

As for the notion that e-cigarettes will inevitably lead teenagers to take up real cigarettes, no one has ever produced any evidence of this so-called “gateway” effect. On the contrary, the C.D.C.’s own survey would seem to refute it rather convincingly. “It appears that rather than serving as a gateway toward cigarette smoking, e-cigarettes may actually be acting as a diversion away from cigarettes,” wrote Michael Siegel, a professor at Boston University School of Public Health, on his anti-tobacco blog. “This is actually a good thing.”

It’s not even all that clear how addictive e-cigarettes are. On Wednesday, BMJ Open, an online scientific journal, published a study of the e-cigarette habits of Welsh adolescents. It found that nearly 13 percent of the secondary schoolers had tried e-cigarettes. But, as BMJ summarized the research, “few of those who try them become regular users.” Graham Moore, one of the study’s authors, told me that “widespread experimentation with e-cigarettes doesn’t seem to be translating into addiction.”

In the Times story about the survey, my colleague Sabrina Tavernise interviewed high school kids who had taken up e-cigarettes. Some of them were using it as “a medicine against cigarettes.” But others were trying them because they looked “cool,” or they liked the flavors.

It is easy enough to understand why such a story might cause public health officials to shudder. It conjures up the bad old days when Big Tobacco used its marketing tricks to convince teens to try smoking because it was cool—after which they were hooked, often for life, with terrible consequences.

Yes, teens are better off if they never inhale nicotine. But equating smoking cigarettes with inhaling e-cigarettes, as the C.D.C. is doing in its messaging around teen tobacco use, is a huge disservice to public health. On the scale of potential harms, e-cigarettes aren’t even in the same ballpark as combustible cigarettes. They have the potential to save millions of lives if smokers could be convinced to switch—which is what the C.D.C. ought to be stressing. Jack Henningfield, a tobacco expert at Pinney Associates, told me that while youths should be discouraged from using nicotine, “putting electronic products in the same basket as cigarettes is not truthful, credible or helpful.”

Invariably, teens do things they shouldn’t; that’s part of growing up. For decades, smoking cigarettes has been one of those things. The fact that they are doing less of it than ever before is not a cause for dismay. It is a cause for celebration.

Via [www.nytimes.com]

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